Dijon University Hospital, Department of Digestive Surgical Oncology, Dijon F-21000, France.
Dijon University Hospital, Clinical Epidemiology/Clinical Trials Unit, Clinical Investigation Center, Dijon F-21000, France.
HPB (Oxford). 2021 Sep;23(9):1410-1417. doi: 10.1016/j.hpb.2021.02.002. Epub 2021 Feb 8.
FTR appears as a major cause of postoperative mortality (POM). Hospital volume has an impact on FTR in pancreatic surgery but no study has investigated this relationship more specifically in DP.
We analysed patients with DP between 2009 and 2018 through a nationwide database. FTR definition was mortality among patients who experiment major complications. The cutoff between high and low volume centers was 20 pancreatectomies per year.
Some 10,632 patients underwent DP, 5048 (47.5%) were operated in 602 (95.4%) low volume centers and 5584 (52.5%) in 29 (4.6%) high volume centers. Overall FTR occurred in 11.2% of patients and was significantly reduced in high volume centers compared to low volume centers (10.2% vs 12.5%, p = 0.047). In multivariate analysis, surgery in a high volume center was a protective factor for POM (OR = 0.570, CI95% [0.505-0.643], p < 0.001) and also for FTR (OR = 0.550, CI95% [0.486-0.630], p < 0.001).
Hospital volume has a positive impact on FTR in DP. Patients with higher risk of FTR are men, with high modified Charlson comorbidity index, malignant conditions and open procedures.
FTR 是术后死亡率（POM）的主要原因。医院容量对胰腺手术中的 FTR 有影响，但尚无研究更具体地研究 DP 中的这种关系。
我们通过全国性数据库分析了 2009 年至 2018 年间接受 DP 的患者。FTR 的定义是发生重大并发症的患者的死亡率。高容量和低容量中心之间的截止值为每年 20 例胰腺切除术。
约有 10632 例患者接受 DP 治疗，其中 5048 例（47.5％）在 602 家（95.4％）低容量中心进行，5584 例（52.5％）在 29 家（4.6％）高容量中心进行。总体 FTR 在 11.2％的患者中发生，在高容量中心显著低于低容量中心（10.2％比 12.5％，p=0.047）。多变量分析显示，在高容量中心进行手术是 POM 的保护因素（OR=0.570，95％CI [0.505-0.643]，p<0.001），也是 FTR 的保护因素（OR=0.550，95％CI [0.486-0.630]，p<0.001）。
医院容量对 DP 中的 FTR 有积极影响。FTR 风险较高的患者为男性，伴有高改良 Charlson 合并症指数，恶性疾病和开放性手术。
